正确的抗生素治疗可以降低鲍曼不动杆菌菌血症的死亡率

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Appropriate antimicrobial therapy reduced mortality rates in A. baumannii

• August 13, 2012
  

Mortality rates associated with Acinetobacter baumannii bacteremia in severely ill patients was significantly improved with appropriate antimicrobial therapy.
“The pathogenecity of Acinetobacter baumannii and the effect of appropriate antimicrobial therapy on this pathogen has been a controversial issue.” TeLi Chen, MD,of the division of infectious diseases at Taipei Veterans General Hospital in Taiwan, told Infectious Disease News. “We confirmed that A. baumannii is associated with a high mortality rate in severely ill patients and that appropriate antimicrobial therapy implemented within 48 hours of bacteremia onset is crucial for the patients’ outcome.”

                               
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TeLi Chen

Chen and colleagues conducted a retrospective study to determine whether appropriate antimicrobial therapy had an effect on 14-day mortality.
通过正确合理的抗生素治疗可以降低14天死亡率。
The study included 252 patients with monomicrobial A. baumannii bactermia.
Overall, the 14-day mortality rate was 29.8%. After multivariate analysis, appropriate antimicrobial therapy was shown to be associated with reduced mortality (OR=0.22; 95% CI, 0.10-0.50). In addition, malignancy (OR=3.48; 95% CI, 1.58-7.68) and APACHE II score (OR=1.18; 95% CI, 1.13-1.24) were also predictors of mortality. 恶性肿瘤和APACHE II分值可以显著增加死亡风险。
Interactions between APACHE II score and appropriate antimicrobial therapy were also observed. Appropriate antimicrobial therapy did not affect patients with APACHE II scores of =15 or scores of >15 and =25. Patients with APACHE II scores of >25 and =35 and >35 had significantly reduced mortality when they received antimicrobial therapy.
“For patients with sepsis and at risk for A. baumannii bacteremia, implementation of an antimicrobial agent that is active against A. baumannii is warranted,” Chen said. “A study evaluating the impact of rapid identification of patients with A. baumanii bacteremia with a rapid identification method followed by implementation of appropriate therapy is ongoing.”

References:

Lee Y. Clin Infect Dis. 2012;55:209-215.

Disclosures:

Dr. Chen is a medical advisor for TTY biopharm..

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国外专家速评：
Despite its retrospective design, this study is very important because it was performed in a large tertiary care teaching hospital over an 8-year period. Furthermore, a well-defined 14-day mortality outcome was used by the authors. In addition, A. baumannii was identified to the genomic species level by using molecular techniques (Polymerase Chain Reaction). The key finding of the study is that appropriate antibiotic therapy was independently associated with markedly reduced 14-day mortality [OR: 0.22, 95% CI: 0.01-0.50, p<0.001]. Interestingly, this reduced mortality was observed in the sickest patients i.e. those with higher APACHE II scores. This finding refutes the belief held by some scientists that A. baumannii is a low virulence bacterium and that patients die not because of it, but rather from comorbidities. Infectious diseases specialists should be aware of this study as it stresses the importance of using appropriate antibiotics in the setting of A. baumannii bacteremia.
Petros Rafailidis, MD
Alfa Institute of Biomedical Sciences, Athens, Greece

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尽管这是一篇回顾性研究，但是却很重要，因为其本研究就在一家大型三级教学医院开展的研究，周期超过了8年。而且，良好的预后结局也为本研究增色（14天死亡率）。此外，通过PCR鉴定方法，确定AB的鲍曼不动杆菌基因型。其关键点在于发现：合理的抗生素治疗可以降低78%14天AB菌血症的死亡率风险。有趣的是吗，这种效应在APACHE 评分高者中更为显著。本文的研究结果反驳了以前学者的理念，认为鲍曼不动杆菌是低毒力的的细菌，不会直接导致患者的死亡，而仅仅来自于一些并发症。感染病专家应该充分意识到正确合理的抗生素治疗对鲍曼不动杆菌菌血症预后的重要性。

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CLIN INFECT DIS杂志属于医学行业，“传染病学”子行业的顶级杂志。影响因子9.14

星火

1. 通过PCR鉴定方法，确定AB的鲍曼不动杆菌基因型。其关键点在于发现：合理的抗生素治疗可以降低78%14天AB菌血症的死亡率风险。

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很多医院不具备确定AB的基因型，甚至耐用性的解读很难？很不易把握抗菌药物的正确应用。

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星火 发表于 2012-8-31 10:00

                               
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很多医院不具备确定AB的基因型，甚至耐用性的解读很难？很不易把握抗菌药物的正确应用。

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小白兔

感叹自己的英语学得太不好了，呜呜！